Healthcare Provider Details

I. General information

NPI: 1710822820
Provider Name (Legal Business Name): SARAH WOODWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5235 STILESBORO RD NW
KENNESAW GA
30152-3968
US

IV. Provider business mailing address

1772 MAY GLEN DR NW
ACWORTH GA
30102-6402
US

V. Phone/Fax

Practice location:
  • Phone: 770-873-5084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA004831
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: